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New ATOP Director Talks Project Progress and Perspective

Nurses

I fully embraced the opportunity to join HealthInsight Nevada as the director of the Admissions and Transitions Optimization Program (ATOP) in October 2016 and take the reins of the Phase 2 project. It has been an extraordinary six months of learning and leading for me with invaluable professional and personal growth. ATOP began in 2012 with Phase 1 targeting 24 nursing facilities in Nevada to receive supplemental clinical resources by making RNs and APRNs available to improve the health care outcomes of long-term residents and reduce health care costs without restricting access to care or choice of provider. ATOP nurses focused on the training and education of facility staff (CNAs, LPNs, RNs) as well as providing direct care (in a teaching manner) to facility residents. This project was driven by a Centers for Medicare & Medicaid Services (CMS) measurement showing that a staggering 45 percent of hospital transfers for this population are deemed potentially avoidable.

Phase 1 concluded in September 2016 with impressive results. The ATOP project in Nevada reported that total spending dropped 21.7 percent per resident on average and potentially avoidable hospitalization occurrences declined by 25.5 percent.

ATOP Phase 2 launched in October 2016 with refined parameters for the interventions being offered. Fourteen of the initial 24 nursing facilities qualified to participate in the second phase. According to CMS data, 80 percent of the potentially avoidable hospitalizations that do occur are caused by one of six conditions - pneumonia, congestive heart failure, skin ulcers/cellulitis, dehydration, urinary tract infections and COPD/asthma. Our clinical resources of 11 RNs and four APRNs are now focusing on providing education and training support specifically related to the prevention or early identification of these conditions, with promising results.

CMS has also added an incentive to the project in the way of payment reform. The payment model encourages identification and proper treatment of the six conditions without a transfer to the hospital. The facilities and attending practitioners are compensated in a manner to encourage treatment in place for a resident whenever possible without compromising the quality of care. The resident benefits by not experiencing the disruption and stress of the transfer and costs are reduced without sacrificing the quality of care.

This program works well because there is a talented team of committed professionals who appreciate being able to make a positive difference. Every one of us is touched directly or indirectly by how our society cares for older adults and I'm proud to be a part of this effort.

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